transgender personen op de werkvloer

Transgender personen op de

werkvloerDr. Joz Motmans

~

Nationale Dagen voor de Arbeidsgeneeskunde

7 november 2014

Overview

• Transgender history & terminology

– What? Who? Where?

• Mental health

– Etiology

– Prevalence

– Psycho-medical care

• Transgender policy at work

• Legal framework

{Transgender history & terminology}

Introduction

A lot of terminology:

• Sexual identity

• Gender identity

• Gendervariant

• Cross-sex behavior

• A-typical gender development

• Gender dysphoria

• Transgender

• Transsexual

• Transvestite

• Transition – RLE - GRS

• …


The 20th century: birth of ‘transsexuality’

• 1930: first sex change surgery: Lilli Elbe

1952: ‘first’ transsexual women: Christine Jorgensen (1952)

Large media coverage, in contrast with story of Michael Laurence

Dillon (1949)

Transsexual phenomenon is born!


The 20th century: birth of ‘transsexuality’

• Harry Benjamin: founding father“The Transsexual Phenomenon” (1966) • Sex reassignment surgery (SRS)

• Normalizing & making trans respectable

• Privilege for the ‘real’ transsexual

• Gender identity clinics: medical treatment is the only right solution

• “Born in the wrong body”-metaphor

• “Male-to-female” or MtF: trans(sexual) woman

• “Female-to-male” or FtM: trans(sexual) man

Birth sex biological given

assignment at birth by others based on external genitalia

“is it a boy or a girl?”

Gender identity psychological feeling of belonging

“are you a man or a woman?”

Gender expression & gender rolesocial-cultural context

external characteristics/expression: clothes, behaviour, hair, speech, …“what do you see?”

Sexual orientationattraction/behaviour/identity

“who do you sexually feel attracted to?”


Sexual identity: different layers on the cake

In all cultures, in all times!


So.. how many people are trans*?

• Epidemiological studies on prevalence and incidence of gender dysphoria or GID or transsexualism have not been conducted

• Crude estimates of prevalence have relied on indirect methods such as clinical samples (different criteria)

• Who gets counted??? (diagnosis, hormones, surgery, ..?)

Who is trans* ? (Belgium) State register1/1/1993 – 30/06/2013 = 676[IGVM, 2013]

Medical records 1:12.900 natal men1:33.800 natal women= 442[De Cuypere, et al., 2007]

Gender dysphoria1 : 2.000 à 1.000 men, 1 : 4.000 à 2.000 women= 3125

[De Cuypere & Olyslager, 2009]

Gender ambivalence2.2% men & 1.9% women =

± 47442 natal women± 54709 natal men

Gender incongruence0.7% men & 0.6% women =

± 14981 natal women± 17407 natal men

[Van Caenegem, et al., forthcoming]

{Mental health}

Psycho-medical care

Diagnostic Statistical Manual of mental disorders 5 (DSM-5)

Gender dysphoria (prev. Gender Identity Disorder / transsexualism)

defined as the discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) (Knudson, De Cuypere & Bockting, 2010)

trans people may experience gender dysphoria at somepoints in their lives (Coleman et al, 2007)

treatment is available to assist people experiencing such distress to explore their gender identity and find a gender role that is comfortable for them (Bockting & Goldberg, 2006).GD can thus largely be alleviated through treatment.

Not ALL trans persons desire medical interventions!

Standards of Care (SOC)

World Professional Association for Transgender Health

(WPATH, see www.wpath.org)

Criteria for treatment (hormonal/surgery)

Evolution from “gatekeeper” to flexible, individualized treatment

{Mental health}

Psycho-medical care

{Mental health}

Psycho-medical care

• WPATH protocol (SOC7)

Assessment: psychiatrist/psychologist &

endocrinologist (min. 6 months)

Cross-sex hormonal treatment: endocrinologist (min.

12 months)

Surgery: plastic surgeon, urologist, gynecologist

• Average time: 2 à 3 years

0

20

40

60

80

100

120

140

1985 1990 1995 2000 2005 2010 sep/14

Aantal nieuwe aanmeldingen op jaarbasis genderteam UZ Gent

(januari 1985 - september 2014)

Meerderjarigen

Minderjarigen

{Mental health}

Etiology?

Biopsychosocial model (a)typical gender development

Limited evidence psychosocial factors

Increasing evidence biological factors

“age x gene x environment”(Lenroot, 2011)

{Mental health}

Regret?

Regret-analysis

• Trans women: 1 à 1,5%

• Trans men: < 1%

Reasons:

• Inadequate diagnosis (strong comorbidity)

• Lacking or disappointing social phase (real life

experience)

• Disappointing surgical results (functional & esthetical)

• No communication about doubts during procedure

• Combination of the points above

{Mental health}

Improving health of trans persons

{Mental health}


Aims To promote mental, physical and social health of trans

people in Europe

To increase the quality of life among trans people in Europe

To ensure trans people’s rights for healthy development and well-being

www.epath.eu

Conference “Transgender Health Care in Europe” Ghent, 12-14 March 2015

http://www.epath.eu/

{Mental health}


Transgender Infopunt

• www.transinfo.be

{Mental health}


• Trans health map (zorgkaart): where can I

find trans health care?

http://transgenderinfo.be/l/zorgaanbod/

http://transgenderinfo.be/l/zorgaanbod/

{Mental health}


Gender passport: over > 70 in first year

{Mental health}


• Zorgpad: transgenderinfo.be/f/zorgpad/

{Trans people at work}

Europe

FRA LGBT SURVEY

• Among respondents who had a paid job at any point during the five years preceding the survey, at least seven in 10 transgender respondents had never or rarely been open about being trans at work in the five years before the survey

• 43% felt discriminated against because of being trans when looking for a job

• 1/3 (30%) of the trans respondents who were employed and/or looking for a job in the 12 months before the survey felt discriminated against because of being trans


Europe


Belgium

• Educational level– 21,8% lager secundair onderwijs– 27,6% hoger secundair onderwijs– 26,3% hoger niet-universitair onderwijs– 24,3% universitair onderwijsGemiddeld hoger opgeleid dan alg. Belgen!

• Employment– 51,2% werknemer– 15,6% werkloos– 11,1% student– 9% zelfstandige (of helper)– 6,1% (brug)pensioen– 5,7% ziek of arbeidsongeschikt


Flanders

In comparisons with cisgender persons, trans

persons:

• are on average more highly educated, but less

often employed

• choose careers in (semi)public or non-profit

sectors and significantly less in private

companies & earn less

(Motmans, Meier & T’Sjoen, 2011)


Een uitgave van de Vlaamse Overheid.De inhoud van de publicatie kwam tot stand in overleg met een heleboel organisaties en individuele experten, zoals UNIZO, Voka, Vlaams ABVV, ACLVB, ACV, VDAB, çavaria, Casa Rosa en GenderExpress.

{Transgender policy at work}

How?

Different possible scenario’s; three basic rules:

1. Don’t make a big deal out of it, not for the trans

person nor for yourself. If you’re not sure how to

address your colleague, just ask.

2. Little things matter: change the things you can,

even before/without official name/gender changes:

think about postbox, e-mail address, business

cards, name badges, etc.

3. Be open and honest, with respect for the privacy of

the person involved


#1 when a trans person applies for a job

• Reminder: a lot of trans persons have experienced discrimination, or do not longer identify with being trans

• No legal obligation for coming out (no fraud)

• Outing often because of CV, legal gender marker, and/or gender expression

• Be discrete towards colleagues / clients: there’s no need for gossip


#1 when a trans person applies for a job

Certificates / diploma • Since 01/09/2012 people whose first name has officially

changed (incl. trans) have the right to have their

certificate replaced with a new one, stating their new

name.

• This prevents problems in future educational enrollment

or when applying for a job

• Legal basis: decree 29/06/2012 “betreffende de

noodzakelijke bepalingen voor de organisatie van het

onderwijs.”


#2 when a trans persons stays in the closet

• As an employer, show your openness to minority

groups, including trans

– Make trans people visible in your EO/diversity policy

– Increase visibility through posters, charter, anti-

bullying policy, …


#3 when an employee transitions on the job

• The team/network changes too

• No attention for trans in EO policy in 95%

– Unknown area

– Manager/HR are not trained/informed

– There are no services at place for problems & care:

‘the persons becomes a test case’

• Make clear arrangements together

– More change for success

– Improves mutual trust & loyalty



“How to announce the gender role change at work?”– Colleagues, clients or pupils

• Communication is everything– Make concrete arrangements concerning the start date, be

concrete about name / she or he

– Express support from the HR-manager, or someone from a high level (underline the legal duties from the management)

– Give resources for more information (websites, leaflets, …)

• Education at two levels: – need for general information about the topic

– individual information to better understand the situation of the person involved (privacy!)



“From which point in time do we need to

‘recognize’ the person in the new gender role?”

• Basic rule: ALWAYS treat your colleague/employee with

respect for his or her identity

• From the moment of coming out/announcement

• No need to wait for legal changes

• Do what you can = change what you can

• Use of sanitary facilities, uniforms / clothes: according to

gender, not birth sex!



“Are there any possible negative effects for his/her capacity to work?”• Most of the times: no effect on work capacity or abilities,

skills or knowledge: same book, different cover!

• Very intense process: sometimes a break is needed– “In between phase”: sometimes need for less public function –

but only when asked for!

• If surgery is planned: most of the times: long waiting lists– Recovery: 1 à 12 weeks / surgery

– Can be planned (communication!)

• When problems occur: invite ‘neutral’ third party for education, supervision, .. – Sometimes relationships in the team change

– Sometimes person involved develops new interests


#4 when a trans is no longer trans

• When social/medical/legal transition is over:

ex-trans

• Transition = medical privacy = confidential information

• Personal disclosure & information = autonomous decision

• Employee ≠ obliged to come out at work or to disclose on

any possible medical interventions

{Legal framework}

Protection against discrimination

• Discrimination of trans people = discrimination based on birth sex

• Gender identity and gender expression are protected grounds for discrimination (2014)

Legal Gender Recognition

• Process of changing the name and gendered information on official key documents and in registries, in order to recognize a person’s gender identity

• Strict medical criteria <-> human rights!

{Legal framework}

(sexual) harassment / bullying

• No separate policy needed

• Royal Decree of 17 May 2007 concerning the

prevention of psychosocial load caused by work,

including violence, harassment and sexual

harassment at work (Belgian Official Journal of 6

June 2007).

• Including gender identity and gender expression

(B.S., 28 april 2014)!

“Humanity is divided in 2 categories: those who

believe that it is possible for humanity to be classified

in 2 categories, and those who believe that it is not.

The majority of people, when discussing the

distinction ‘men vs. women’, belong to the first group.”

Citation Peggy Cohen – Kettenis,

VU Amsterdam, The Netherlands

Transgender Infopunt

www.transgenderinfo.be

[email protected]

T 0800 96 316 (thu & fri)

http://www.transgenderinfo.be/

mailto:[email protected]

transgender personen op de werkvloer

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